During my checkup with my PCP, she suggested that at age 70 I might want to have a CT Coronary Calcium Study done to see if there was plaque developing in the blood vessels around my heart. I’d never heard of this test, but even though I had no symptoms I figured it couldn’t hurt.
I eat healthy, exercise regularly, and have never had any symptoms of heart disease. My blood panel showed that my LDL-C was higher than it should be and my HDL-C was lower than it should be, and my PCP has just put me on a stronger statin to get things back to where they should be. I’ve been taking a statin for 40 years due to a Familial Hypercholesterolemia diagnosis when I was 30.
To my surprise, the calcification on the Left Anterior Descending Artery, also known as the window-maker, came in at 438, which is extremely high and means I have plaque building up in that particular artery. My other coronary arteries weren’t nearly as bad, but I knew I had to do something about that one.
My PCP referred me to a cardiologist, but the soonest appointment I could get was in mid-July. I know they have a variety of options from cleaning out the artery to installing a stent to deal with these kinds of problems, but I don’t know what to expect when I meet with the cardiologist.
Has anyone who has ever had an experience like this tell me what is likely to happen when I meet with the cardiologist? Will they do a stress test? Will they somehow verify that the artery is becoming blocks by plaques? I’d like to know what to expect before I arrive at his office.
Since you state you are symptom free, next most likely would be a stress test. Or if based on your history, labs and exam your CV doc thinks you’re really high risk for short term cardiac problems, you might hear a recommendation for a cath.
You could also end up with a recommendation for just more aggressive risk reduction via diet, exercise, weight loss, and possibly adding some other pharmacologic agents like zetia and/or others.
I haven’t examined you or seen all your data, plus I’ve been out of practice for 3 years, plus I’m not a cardiologist, just a retired family doc.
Good luck, been there and done that for patients and had it done to me too. 7 stents later I’m still chugging along. But I was higher risk than you, per what you’ve posted.
I suspect the cardiologist will ask you to have a cardiac catheterization done, where dye is injected into the heart so it can be scanned to see just where and how bad your arteries may be clogged. The test itself is considered low-risk and is often done while patients are awake (but sedated).
With those results they’ll have a better idea of what to do next.
ETA: I yield to Qadgop’s first-hand knowledge of the sequence of diagnosis.
I should mention that things can move quickly if you fail the stress test. I went in for one in 2000 and they promptly put me in bed and scheduled my triple bypass. That was on Friday before Labor Day so they could not schedule it unlit the following Tuesday. They didn’t even want me out of bed.
I am absolutely not an MD of any kind, but I am a former and current cardiac patient and I can basically attest to this, plus @Qadgop_the_Mercotan’s first-hand knowledge. Cardiac catheterization is mainly observational, though it can be used to widen arteries, but I have no idea how often this is done.
Very much the same technique is used for implanting stents, called Percutaneous Coronary Intervention. What I can tell you from having had PCI done is that while technically there is some very small risk, as there is with each and every medical procedure, it’s really a nothingburger. In fact, when nicely sedated with good drugs and lying down in a science-fiction like cath lab with robots zooming around over you, I daresay it almost verges on being a “fun” experience!
I wouldn’t call it a ‘nothingburger’. Yes, it’s generally safe for most folks, but bad stuff happens. I’ve seen patients who had acute MIs triggered by caths, along with coronary artery dissection, strokes, and folks who had to be rushed to emergency bypass because of complications during the procedure (including my own father). These may occur less often than 1 case in 100, but with thousands of caths being done across the country daily, they do add up fast. Add in the manipulation done by angioplasty, and risks are increased
That’s why it’s important not to minimize what the cath risks are vs. the rewards, and explain the particulars to the patient, focusing on their particular case.
Thank you for the informed clarification. I do recall having to sign a release form, and the head of the cath lab, who performed the PCI with the assistance of some more junior doctor, told me that among other things, it could trigger a heart attack, but such side effects were very unlikely.
I suppose what I should have said was that it was a nothingburger for me personally because the best recommendation for my condition was triple-bypass cardiac surgery. Now there is a Big Deal if there ever was one, in terms of everything – risk, recovery time, major discomfort, whatever.
So I pretty much flat-out refused it and begged them for PCI. They eventually decided that it would work, but might have to be permanently managed by medication thereafter. And the procedure was so simple that it was a blessed relief, and led to my comment. And as I’m sure you’re very well aware, a modern catheter lab is a wondrous place with some really fancy equipment and robotics. When you’re stoned out of your mind but still fully awake, being in there is like being transported into the future!
As for the medications, I keep getting prescribed blood pressure medication and a blood thinner, but I admit that I often fail to take them. Over the subsequent 6 or 7 years (it might be even longer) I’ve had no issues whatsoever. Take that for what it’s worth, which I freely acknowledge is worth exactly the same as any other free information over the internet!
It’s kinda like air travel. Due to a lot of diligent work by a lot of people, taking a plane to wherever is generally a nothingburger in terms of difficulty and delivers just the result you want.
But once in awhile things go badly awry and a world of hurt comes next instead.
Let me toss in one more personal experience. I was at a point in 2020 when just walking upstairs left me hugging a wall until I could get back my breath. My PCP scheduled a stress test. During the walk-until-you-can’t phase I lasted maybe two minutes and almost collapsed. They sent me straight to the cardiologist who scheduled a stent. No go. My arteries were 90% blocked. The triple bypass took a month to be scheduled. That operation went very well. But those 1 in 100 complications? I had a different one in each lung. Very ironic and not good.
Since I obviously can’t take a regular stress test any more I was given a nuclear stress test. I reacted badly to the nuke IV and went into shock. They gave me an IV of liquid caffeine. I walked out of there in the sunniest high I’ve ever had, never having used drugs. Always ask for LC, the Sunny High™.
A number of years ago I got off the bus and started walking home. After about twenty feet I found myself gasping for breath and holding on to a signpost to keep from falling. After a few minutes I managed to walk the rest of the way to my house and immediately called 911. After a few tests in the ER they booked me a room and set me up for a catheterization. I was drugged but more or less conscious during the procedure, so I was able to hear the doctors discuss the state of my arteries and decide that I needed to have two stents installed. Unfortunately they lied to me about being able to see the monitors; I would have liked to have seen the inside of my body. I was sent home in a day or so, and had to do cardio rehab and got put on a bunch of drugs, some of which they took me off of after a while.
One of the side effects of this was when they had done the CT scan while I was in the ER it was discovered that I had some minor liver damage. So I also had to follow up on that; fortunately it turned out to be not too serious. Except that I was told not to have anything alcoholic.
Put them someplace where you sit down every day-- at the breakfast table, in front of your computer, in front of the TV. No excuses will be tolerated by the Management. Get with the program!
[I keep my meds and vitamins in their original bottles in the drawer of my coffee table, which is where I eat most of the time. I dispense the pills into an egg cup (the kind for soft-boiled eggs) each day at mealtime. Some people keep their meds in those compartment-a-day plastic thingies, but setting that up once a week was too much of a chore for me.]
Develop a system that works for you and then DO IT!
Not my field clearly but my limited understanding has been that lesions identified on the CAC are generally considered stable? (Hard vs soft plaque.) My understanding was that the CAC score is generally used as an additional bit of information to possibly stratify someone borderline up or down in risk.
Nope, that’s it, which is why I don’t think a case of high score should be sent for catheterization just on that. To me the score is just one more factor in patient assessment. As you have already demonstrated that you know so well (and have probably already said here), we should treat the patient and not the test. I could have put that more concisely in my response.
My breathing is fine. I power walk 7 miles a day and lift weights mornings and nights. I feel better now than I did when I was 30. I have no symptoms of cardiac disease, just a lousy calcium score.
I can understand your concern and fears, but at this point I wouldn’t panic. Your course of action may not be nearly as dramatic as most of the cases cited here. I was given a stress echo cardiogram after a similar calcium score at the age of 60. It came back normal and I was given a statin and started aspirin therapy. I’ve had a few more stress echo’s over the last 15 years which continue to be normal and I’m still on the statin, although I’ve stopped the aspirin.
It was explained to me that the hardened plaque, which the calcium score shows, is relatively safe plaque. The soft plaque, which is not shown by the calcium score test, is the dangerous kind that more likely causes heart attacks and stroke. The reason for the statins and aspirin is to help prevent the soft plaque from causing a problem.
Thanks for your comments Yosh99. I wasn’t aware of the two different types of plaque. I’m hoping I’m in the same boat as you are. Does the fact that your stress echo was normal mean you don’t have any issues with soft plaque? Or is not that simple? As there other tests available that can measure whether you have lots of soft plaque or not?
I had taken aspirin for many years, along with a statin, and one of my doctors told me aspirin wasn’t necessary, so I stopped taking it about 10 years ago. My current PCP just put me back on aspirin and switched me to a more potent statin that should knock down my LDL into the normal range. It will be interesting to hear what the cardiologist has to say about all this.
Take your freakin’ pills.
